Laboratory Studies

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Microbiologic studies in Campylobacter infection

Presumptive diagnosis can be made by examination of fecal specimens by darkfield or phase-contrast microscopy, which demonstrates the characteristic darting motility, and a Gram stain of the stool, which shows Vibrio forms (slim, short, curved rods). RBCs and neutrophils are present in stool in approximately 75% of patients with Campylobacter enteritis.

Definitive diagnosis of infection is based on isolation of organisms from stool culture or from another site.

Culture of C jejuni from stool requires special isolation techniques and special media such as Campy-BAP or Skirrow. These media contain antibiotics that reduce the emergence of other enteric microorganisms. Inoculated media should be incubated in 5% oxygen and 10% carbon dioxide at 42°C. If C fetus or other atypical enteric species are suspected, isolation from stool requires inoculation on media lacking antibiotics and at 37°C. Filtration technique may be needed. Routine media are adequate for isolation of Campylobacter from normally sterile sites such as blood, body fluids, and tissues.

Hematology and blood chemistries

Peripheral WBC count is usually within the reference range; however, a left shift may occur.

The alanine aminotransferase level and the erythrocyte sedimentation rate (ESR) may be slightly elevated.

Other laboratory evaluations are within the reference ranges.

Serology

Diagnostic rise usually occurs after symptoms have resolved. Because the median duration of fecal excretion in the convalescent phase is less than 3 weeks, serology testing may be more sensitive than culture for the diagnosis of recent C jejuni infection.

Although serologic testing is also useful for epidemiologic investigations it is not recommended for routine diagnosis.

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Other Tests

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DNA probes and polymerase chain reaction are mainly research tools at this time and are not routinely performed.
[24]

A reanalysis of a case-control study by Liu et al reported that Campylobacter jejuni incidence was two times greater with quantitative real-time PCR than with methods including culture, EIA, and reverse-transcriptase PCR.
[25]

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Procedures

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In patients with Campylobacter colitis with history of acute onset of diarrhea, abdominal pain and rectal bleeding, sigmoidoscopy done early (within 5 d) during the illness revealed hyperemic rectal mucosa with occasional shallow aphthous ulcers, whereas findings of granularity and hyperemia were seen in patients whose sigmoidoscopy were done later (≥ 7 d) during the illness.
[26]

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Histologic Findings

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The spectrum of histologic findings in the intestinal tract ranges from minimal edema with acute and chronic inflammatory cells without vascular congestion, to moderate inflammation and cryptitis, to crypt abscess formation.

For perinatal infections secondary to C jejuni and C fetus, the placenta may have areas of necrosis, infarction, microabscesses, and inflammation.
[19]

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School